Tuesday, 11 December 2012

Fertility Math

Since I haven't really written a lot about my infertility journey, I thought I'd do a post with a bit of a rundown of how we got here.  We're a bit lucky in that we were diagnosed and started treatment fairly quickly due to the fact that I was over 35, so we haven't been struggling with years and years of trying to no avail.

After M and I got married in April 2011, we actually decided to hold off for a little bit on having kids as we wanted to just enjoy being newlyweds for a while.  But I didn't want to wait too long, given the age factor.  Plus, I always just kind of had a feeling we'd have a hard time.  I don't know why.  Part of it was probably due to the fact that for the previous year or so I had been noticing spotting anywhere from up to 4 days before my period, which was new for me.  There was no firm answer online as to why this was happening, but I seemed to find a lot of women struggling to conceive who had the same issue.  Clue Number 1!

Clue Number 2:  After a few months with no success, I started temping and using OPKs.  The OPKs were always touch and go for accuracy, but the temping showed a pretty clear thermal shift.  The problem was that it was happening way earlier than I thought.  I seemed to be ovulating on Day 9 or 10 instead of Day 14.  Again, that was weird, but I just figured we needed to move our babymaking schedule up a bit and get started on Day 6 or 7 of my cycle so we could catch the egg.  No dice.

Because I'm such a gloomy little cloud of pessimism (plus I'm hyper-organized), I moved quick and got us in with an RE shortly after the "6 months trying after age 35" rule expired.  Here's what we've learned after a few months of cycle monitoring and which led to our diagnosis of Diminished Ovarian Reserve.
  • Day 3 Estrogen (E2):  high of 402 pmol/L, low of 265 (that's 110 pg/ml and 72 pg/ml for my American friends).  Normal range is 25 - 75 pg/ml.  I got the 265 after three months of CoQ10, so I wonder if that's actually been doing me some good?
  • Day 3 FSH:  low of 5.3 (when E2 was 402), high of 6 (when E2 was 265).  Normal is under 10.  Obviously, my FSH is suppressed with the higher estrogen.  However, even when I managed to barely squeak in under the normal E2 range, my FSH was still well within normal limits.  My RE says she does not believe I have elevated FSH.  One of several numbers that don't make sense in my case, since if I have DOR I should most definitely have elevated FSH.
  • AFC: low of 13, high of 17.  Normal is 15 - 30 between both ovaries.  Borderline low, but not horrible.  But....
  • AMH: 1.2 pmol/L, or 0.17 ng/ml.  This puts me into the "very low/undetectable" category.  My RE showed me a chart of AMH corresponding with the normal aging process.  My AMH score means that my ovaries have a biological age somewhere around 43.  I should not have very many left, and what I do have should not be of good quality.  But again, the numbers are wonky.  With an AMH this low, I should have an incredibly low AFC and high FSH in the bargain.  I don't.
The confusion continued with our first IVF in October 2012.  When I went in for my baseline Day 0 scan, guess how many antral follicles I had?

23!!!  This puts me squarely in the "normal" category and almost made my RE change my starting dose of 325iu Gonal F out of fear that I'd overstimulate.  Unfortunately, that turned out not to be a worry.  Here's how our first IVF numbers broke down:
  • 3 days of stims:  E2 at 220 (60 US).  They wanted it to be around 400.  Only one measurable follicle growing; the remaining 22 are sitting tight.
  • 5 days of stims:  E2 at 488 (133 US).  Doubled, but still not as high as they want it.  Three on the left (14, 8, 8) and one on the right (10).
  • 7 days of stims:  E2 at 1175 (320 US).  Again going up, but primarily due to one follicle.  Four on the left (17, 11, 11, 8) and one on the stubborn right (11).
Based on this, my IVF was cancelled and we switched to IUI, knowing that it likely wouldn't work but not wanting to waste the drugs.  My RE said that she thought that, despite the fact I had been quite suppressed on BCP and Lupron, I still managed to recruit a dominant follicle in the cycle prior to the IVF.  But then she later said that she thought I was oversuppressed, based on the response of the 18 follicles that didn't do anything at all.  I have no idea how I can be both oversuppressed and an early recruiter, but there you go.  Officially, I now fall into the category of poor responder and will be bumped up to a max dose of 450iu Gonal F plus Menopur for my next cycle, which will be antagonist versus long Lupron. 

Anyway, I'm not sure if anyone out there is better at fertility math than me, but my numbers don't seem to add up.  When I got the news of the 23 resting follicles at my baseline scan, I actually allowed my naturally Eeyore-ish self to get optimistic and excited about the cycle, which made it all the more painful when it failed.  I just don't understand why the numbers don't make sense, and all the internet research in the world hasn't found me any answers or anyone who has these same contradictions.  My RE and naturopath have both shrugged their shoulders and said it doesn't really matter.  What we do know is that I am clearly not able to get pregnant on my own and it's looking increasingly doubtful that science can help, as my eggs are likely shit.

But onwards we go.  Denial ain't just a river in Egypt.

7 comments:

  1. I have wonky numbers, too, and I'm also DOR. I've only had one day 3 test: normal FSH and high E2 - and my AMH was 1.37, which is not so bad - yet, I turned out to also have a dominant follicle, like you. Same thing: cycle converted to an IUI. Talk about a nasty surprise.

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  2. I was a poor responder my first time, as well. I only had 1 mature egg. I'm actually surprised the cycle wasn't cancelled. The 2nd time I got huge doses of menopur and follistim from the beginning and got 5 mature eggs. My RE said just because you are a poor responder once,doesn't mean you will always be a poor responder. Every cycle is different. I bet the change in protocol and not being suppressed with lupron will make a huge difference.

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  3. I've been at this for a full two years now and I still don't understand this shit. I've had symptoms and b/w that has even stumped my RE a few times. Why is it that things can't be as cut and dry as they are for everyone else? So, this season I instead drown myself in eggnog spiked with copious amounts of rum (it makes all the numbers a bit blurry; I swear it helps).

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    1. I'm working on your suggestion as I type. Note to self: buy more rum.

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  4. Those numbers are confusing, but if there's one thing I've learned (mostly from reading other people's blogs, as I've yet to really start my first IVF cycle) it's that numbers aren't everything. You've got one (shitty) cycle under your belt. Hopefully what didn't go well then will be a lesson for your next cycle. Fingers crossed.

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  5. Hi from ICLW! Glad to have found your blog, we seem to have a lot in common!

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  6. I'm so glad I found your blog (even if I am replying to months-old posts...) I've got the same diagnosis, but 'luckily' for me [heavy sarcasm here] my numbers are very consistent (all are in US units):
    FSH 13.7 mIU/mL
    E2 24.6 pg/mL (but as I understand it, irrelevant with that FSH)
    AMH 0.17 ng/mL
    And best of all:
    AFC 3 (really, 3; best I've had is 6)

    The only number inconsistent with all the above is my age - 34. From what I can tell, I'm pretty much screwed, but still sufficiently in denial to defer moving on to donor eggs...(The 'good news' [more sarcasm] is that there's no time limit on IVF with donor eggs, right?)

    Anyway, just wanted to say I LOVE your blog, and all your comments on other blogs (yeahscience and mine to command are two others I've been catching up on).

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I'm needy and your comments validate me. Help a sister out!